[20mg tablets 5 cents]
- Fluox, Prozac
- AntidepressantNote: it is rare for antidepressants to be commenced in patients in the ICU. Most ICU patients have ‘situational depression’ and the risks of medication often outweigh the benefits. (see WARNINGS)
PRESENTATION AND ADMINISTRATION:
Fluox 20mg capsules (purple / light green), Prosac 20mg capsules (green / cream)
Fluox dispersible 20mg tablets (white)
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
- Dose in renal impairment [GFR (ml/min)]
<10: dose as in normal renal function or on alternate days
10-20: dose as in normal renal function or on alternate days
>20-50: dose as in normal renal function
- Dose in renal replacement therapy
CAPD: dose as in normal renal function or on alternate days
HD: dose as in normal renal function or on alternate days
CVVHDF: dose as in normal renal function or on alternate days
DOSAGE IN PAEDIATRICS:
0.5mg/kg (max 20mg) daily, increase to maximum of 1mg/kg (max 40mg) 12 hourly
- Fluoxetine is a serotonin specific reuptake inhibitor antidepressant
- hypersensitivity to fluoxetine or other SSRIs
- Use in Patients With Concomitant Illness
Clinical experience with Prozac in patients with concomitant systemic illness is limited. Caution is advisable in using Prozac in patients with diseases or conditions that could affect metabolism or hemodynamic responses.
Patients with major depressive disorder (MDD), both adult and paediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behaviour (suicidality) or unusual changes in behaviour, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs.
Cases of hyponatremia (some with serum sodium lower than 110 mmol/L) have been reported. The hyponatremia appeared to be reversible when Prozac was discontinued. Although these cases were complex with varying possible aetiologies, some were possibly due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH).
Anaphylactoid events, including bronchospasm, angioedema, laryngospasm, and urticaria alone and in combination, have been reported. Pulmonary events, including inflammatory processes of varying histopathology and/or fibrosis, have been reported rarely. These events have occurred with dyspnea as the only preceding symptom.
Published case reports have documented the occurrence of bleeding episodes in patients treated with psychotropic drugs that interfere with serotonin reuptake. Subsequent epidemiological studies, both of the case-control and cohort design, have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding.
- Laboratory Tests:
No tests in addition to routine ICU tests are required.
- Drug/Laboratory Test Interactions:
IMPORTANT DRUG INTERACTIONS FOR THE ICU
- The combination of Tramadol and SSRIs should be used with caution due to the increased risk of serotonin syndrome with concomitant use. Patients on stable doses of phenytoin and carbamazepine have developed elevated plasma anticonvulsant concentrations and clinical anticonvulsant toxicity following initiation of concomitant fluoxetine treatment.
- Body as a Whole:
- Cardiovascular System:
- Digestive System:
Nausea, diarrhoea, anorexia, dry mouth, dyspepsia
- Nervous System:
Insomnia, anxiety, nervousness, somnolence, tremor
- Respiratory System:
- Skin and Appendages: